Dirty needles, dirty dealings

Documentary draws attention to the role of hygiene in HIV transmission in Libya.

There are two accounts of how hundreds of children in a Libyan hospital mysteriously contracted HIV in the late 1990s. One says unhygienic medical practices fuelled the outbreak. The other argues that medical workers murdered the children possibly in a plot sponsored by the CIA and Mossad, the Israeli intelligence service.

Mickey Grant explores both accounts in his documentary Injection, which he released last week for free viewing on the Internet. By releasing the film now he hopes to bring attention to the plight of the five Bulgarian nurses and the Palestinian doctor who face the death penalty in Libyan courts on charges of intentionally infecting children. A verdict is expected soon after the court adjourns on 31 October.

The free Internet release was necessary because, Grant says, he could find no buyers for Injection upon its completion this year. This despite the fact the film-maker has several widely seen documentaries under his belt, including China Run, a film about the long-distance runner Stan Cottrell that aired on HBO and in dozens of cinemas. "I couldn't figure out what it was," says Grant. "Generally they said it looked negative, like it was going to be an unpleasant story."

Close-ups

In one moving segment, Grant uses archive Bulgarian news footage in which one of the accused nurses describes being jailed without knowing the charges, confessing to murder under torture and then retracting her confession.

Equally compelling are Grant's stories of the use of dirty needles in Africa. One man tells how his family received injections of malaria medicine from a single needle, transmitting HIV from one member to another. Grant also interviews the owner of a clinic in a slum in Nairobi, Kenya, who sells non-sterile, loose, used needles; the film traces the source to a city dump, where children scavenge for needles from trucks arriving from the city hospital.

From such anecdotal evidence it seems clear that unhygienic medical practices are rife in Africa. Grant also relays rumours that Muammar Gaddafi, the Libyan leader, had cut off the delivery of medical supplies to this hospital in response to a failed assassination attempt in the region.

The notion that poor hygiene was a problem at the Libyan hospital concurs with a major scientific report by Luc Montagnier at the Pasteur Institute in Paris, France, and Vittorio Colizzi, an AIDS researcher at the University of Tor Vergata in Rome, Italy.

Number game

The World Health Organization (WHO) estimates that dirty needles account for 2.5% of transmissions in sub-Saharan Africa, and many independent experts concur. But Grant claims that this is a vast underestimate, made in part out of fear of scaring Africans away from medical care. Some studies point to figures as high as 40%, Grant says in the film. But it is hard to assess the argument, with little evidence for the WHO figures presented in the documentary.

Colizzi told news@nature.com that he agrees the WHO underplays the problem of dirty needles in Africa. "If more attention were paid to this issue, the tenor of the trial in Libya might be different," he says.

While Colizzi's study suggested that unhygienic medical practices were involved with the Libyan HIV outbreak, he says is not clear to what extent dirty needles, unsafe invasive procedures or other unhygienic procedures were responsible. He says he would have liked to see this explored more thoroughly in the film.

Grant says he would have liked that too, but politics kept him from delving too deeply into this particular case. Grant's bleak footage of himself alone in Libyan hotel rooms, while officials are apparently stymying his attempts to film in the country, tells a vivid story.

"Gaddafi is a dangerous man," says Grant, who says he was followed by government officials during his time there. "Everything in Libya revolves around him."